The National Congress XXXI SERAM (Sociedad Española de Radiología Médical) will take place from 25^th to 28^th May 2012 in the city of Granada, Spain. The SERAM conference traditionally serves as a forum for open discussions on the latest advancements in medical imaging and this year will feature a specialist training course on functional imaging in Oncology, covering diagnosis, staging, treatment, and monitoring. For further information on full programme events, a dedicated site to the conference (in Spanish), can be found here: www.seram2012.com

Claudio Rose from ImageAnalysis will be representing ImageAnalysis and available to discuss our software platform Dynamika and the R&D services we provide to support pre-clinical and clinical trials in rheumatology, oncology, neurology and cardiology.

To arrange to meet with us in Spain in order for you to discuss your work, how we can help, and to have a live demo of Dynamika, please feel free to contact us on info@imageanalysis.org.uk

The conference is held only once a year and attracts radiologists from across the globe. The programme of events includes talks by distinguished researchers on their latest research in the radiology field, as well as a number of hands-on workshops.

For further information on the event, the German Congress of Radiology have a dedicated site (in German) outlining the programme details: http://www.roentgenkongress.de/

To arrange to meet with Adrien during his stay in Germany, and to learn more about ImageAnalysis, please feel free to contact us on info@imageanalysis.org.uk

We look forward to meeting you in Germany !

The programme features analysis by leading experts on the American market and specifically tailored business introductions. The next few years are set to be a period of high growth for ImageAnalysis and the US medical market is key during the next stage of development.

Santander’s Breakthrough programme was launched to help fast-growth companies looking to invest and grow their business. The programme provides up to £200 million of growth capital, and in addition to finance, offers access to a range of support and development programmes. Further information can be found on the Breakthrough website: www.santanderbreakthrough.co.uk.

If you would like to arrange to meet with Dr. Kubassova during her US visit please feel free to email info@imageanalysis.org.uk .

We, at Image Analysis, are convinced that the best way to perform quantification is through easily understandable, visual but yet quantitative assessment, which can be achieved using software platforms, like Dynamika. To achieve objective and precise quantification, the software should incorporate standardized algorithms aiming to automate clinical routine procedures such as image loading, reporting and more sophisticated, such as patient motion correction and defining a region of interest. In this context, standardized algorithms mean the ones which are built on a solid scientific background and have been tested and evaluated in multiple locations.

Of course, many would argue that medical images, such as MRI come from different scanners and often cannot be compared. In order to deal with the differences in image appearance and perform quantitative analysis, we deploy what is knows as ‘modelling’ approach.

Modelling is in effect replacement of actual signal intensity vs time curves extracted from DCE-MRI with a model. This could be a Tofts, Larssen, etc model or a parametric based approach – all of which should be standardized. Modelling of DCE-MRI with one of the pharmacokinetic models, has enabled physiological characteristics of tumours and other lesions to be measured, as an aid to monitoring disease progress and treatment response.

PhD research work of Paul Tofts identifies several key principles for modelling in a quantification procedures. These are

1. Relate the model to the known tissue physiology
2. Use the simplest possible model that fits the data
3. Ensure the fit is independent of starting values (use constraints)
4. Identify the influential fixed parameters (related to the instrument, CA and tissue) and measure the
sensitivity of the fitted parameters to these.
5. Use repeated imaging (if possible) to estimate measurement variance
6. Use phantoms (if possible) to measure accuracy
7. Output goodness-of-fit parameters (e.g. rms residual) and exclude fit failures
8. Estimate (if possible) fitted parameter variance from Hessian (beware parameter covariance)

Read more here: http://www.paul-tofts-phd.org.uk/talks/esmi2012_abstract.pdf
or
Contact us to get a free trial of Dynamika to make quantification measurements with either Tofts models or parametric based approach. Training is available on request.

Dynamika Enterprise is the first server based version of the Dynamika Workstation software for quantitative analysis of MRI and dynamic MRI studies .

Dynamika is standardized CE marked image analysis software that incorporates advanced image analysis algorithms for patient motion correction, image quantification and reporting.

Using the latest software release, you can benefit from:

• Flexible multi user licensing
• Multi-user report sharing and browsing
• 3-D Visualisation and Advanced functionality allowing working with 3D regions of interest
• Volume rendering and Maximum Intensity Projections of volumetric data
• Automatic Region Of Interest drawing around an anatomy of interest

To make your workflow a little easier, we integrated a feature we call ‘Workspaces’ :

Your workspace is automatically saved on closing Dynamika and you are offered the option to open the last workspace when starting Dynamika

Dynamika Enterprise fully supports PACS (including Windows XP, Windows 7)

Along side of the Dynamika Enterprise solution we are providing updated Dynamika Workstation v.4.6.0, which can work on your laptop or netbook and does not require server connectivity.

To get a FREE trial or arrange a Demo, email or call:

info@imageanalysis.org.uk

44(0) 113 3944208

It is important to empathise that in the UK 1.2 million people are employed in the IT workforce but just 23% of it is female. Olga’s great ambition is to encourage women to pursue their goals and inspirations, whether it is setting up a business or becoming an engineer. A speaker at many school and university events, Olga is incredibly pleased with this nomination which might give an opportunity to reach to more girls and women who might need just a gentle nudge to embrace their dreams and not being afraid. Olga, who received Masters in Mathematics from St. Petersburg State University, Russia and Information Technology from Lappeenranta University, Finland, believes that engineering and maths education, which were thought of as male domains, actually can give a wealth of career opportunities for women. Having a solid background like that will help to excel in any later chosen profession – would that be art or business.

The Cisco everywoman in Technology Awards will be held in Savoy, London hotel, United Kingdom on 29^th March 2012. More information, http://www.everywoman.com/techawards

Marco Amedeo Cimmino, Francesca Barbieri, Mikael Boesen, Francesco Paparo, Massimiliano Parodi, Olga Kubassova, Raffaele Scarpa, Giuseppe Zampogna

Clinica Reumatologica, Dipartimento di Medicina Interna, Università di Genova, Genova, Italy,
Department of Radiology and the Parker Institute, Frederiksberg Hospital, Copenhagen Denmark,
Divisione di Radiologia, E.O. Ospedali Galliera, Genova, Italy,
Image Analysis ltd, Leeds, UK,
Clinica Reumatologica, Università di Napoli, Italy.

Figure: Representative parametric maps of DCE-MRI data of ME superimposed on an axial T1-weighted dynamic MRI of the wrist in a patient with psoriatic arthritis (PsA) and another one with rheumatoid arthritis (RA). The ROI containing the wrist synovial membrane is designed in light blue color; those around the tendon sheaths are yellow. The different synovial compartments evaluated are outlined (SYN = joint synovial membrane; E I-E III =first to third extensor compartment; F I-F II = first and second flexor compartment). In this example tenoynovitis prevails in PsA and joint synovitis in RA.

Abstract

Introduction: Dynamic contrast-enhanced MRI (DCE-MRI), the quantification of enhancement within the synovial membrane and bone by extracting curves using fast T1-weighted sequences during intravenous administration of contrast agent, evaluates synovitis and bone marrow edema in psoriatic arthritis (PsA). In this pilot study, we looked at possible differences between joint synovitis and tenosynovitis in PsA as compared with RA.

Patients and methods: 7 patients with PsA and 10 with rheumatoid arthritis were studied. After DCE-MRI was performed on three axial slices of the wrist, the enhancement ratio was calculated on six different ROIs of the synovial membrane outlined by the operator: the wrist compartment, three extensor tendon compartments, and two flexor compartments. DCE-MRI results were quantitatively analyzed using the Dynamika software, a computer-aided semi-automated method.

Results: in PsA, the area of the ROI designed around the first and second extensor compartments was larger than in RA; the opposite was true for the extensor carpi ulnaris region. The volume of inflammation was significantly higher in RA than in PsA for all the extensor compartments, except the second, and in the joint synovial membrane. The DCE-MRI indicators of the degree of inflammation were higher for PsA in the joint synovial membrane (p=0.002 and p<0.001, respectively). There was a significant correlation between volume of inflammation, but not its degree, and DAS28 at the level of the wrist joint (r=0.6; p=0.01).

Conclusions: our results support the view that DCE-MRI can reveal useful and potentially clinical important information of the characteristics of different types of arthritis.

Key words: psoriatic arthritis, rheumatoid arthritis, synovitis, tenosynovitis, MRI, dynamic magnetic resonance imaging

Figure: DCE-MRI parametric maps of the wrist in a patient with psoriatic arthritis during anti TNFα treatment, at baseline (A), and after one (B), and 6 months (C) therapy. Note the clear decrease of enhancement in the joint synovial membrane and in the synovial sheath of the flexor carpi radialis.

The data presented in the article emphasizes the possibility to discriminate between different localizations and components of inflammation in the arthritic synovial membrane. No difference was observed in the volume and degree of inflammation between tenosynovitis, divided in extensor and flexor tenosynovitis in the different compartments, and joint synovitis. Post-treatment decrease of synovial inflammation tended to be more pronounced in the extensor tendon sheath, although not significantly. MRI surface calculations highlighted the wrist synovial sheaths that are more frequently involved in PsA (1st and 2nd compartments of the extensor tendons) and RA (extensor carpi ulnaris).

These significant differences in tendon compartment areas were independent from the activity of the included synovial membrane. In the synovial membrane of the wrist joint, a peculiar behavior was observed when comparing PsA and RA: the volume of inflammation was higher in RA but its degree was higher in PsA. This is particularly intriguing because disease activity, measured by DAS 28, was significantly higher in RA compared to PsA.

It is possible that DAS28 is a surrogate of the amount of inflammation rather than of its intensity, as demonstrated by the significant direct correlation between DAS28 and Ntotal. This finding is different from that observed in our previous comparison on DCE-MRI in PsA and RA, where a similar degree of inflammation was observed, after correction for general disease activity. However, in that study a user-designed ROI was analyzed in the wrist where the maximum enhancement was visually
identified and only the equivalents of IRE and ME were studied.

It is possible that more advanced and precise tools for quantification of the different parameters of DCE-MRI, such as the Dynamika software, could give a more detailed insight of the different aspects of synovitis. As an example, pixels with the wash-out behavior were more often seen in RA in most of the compartments studied.

In this study, we tried to dissect the inflammatory component of joint synovitis from that of tenosynovitis to look at possible difference within and between diseases. In clinical trials the focus is on one joint region without inclusion of tenosynovitis. However, including tenosynovitis in the analysis might be a potential advantage as this feature is part of the inflammatory load of the individual patient. This is supported in a recent publication showing that the combination of RAMRIS synovitis, BME and a novel tenosynovitis score revealed higher standardized response mean duringanti-TNFa treatment than each parameter alone.

There are few limitations in this study. First, the number of examined patients is small, a fact that could account for the lack of significance in the comparison of the different synovial compartments or in the follow-up of treated patients. In spite of this limit, we could demonstrate a different behavior of synovitis in the two diseases, supporting the view that DCE-MRI and its interpretation by Dynamika could represent a valid tool to investigate various types of arthritis.

Second, RA patients had more active disease than PsA ones, a fact that is commonly encountered in clinical practice. The absence of comparability of the two groups contributed to stress some differences revealed by DCE-MRI. Third, it is difficult to understand the complete significance of the findings of this pilot study in the absence of follow-up evaluation and correlations with different disease features.

Finally, the grouping of tendons in five compartments was somewhat arbitrary and based on the feasibility of ROIs positioning. In spite of these limits, we feel that DCE-MRI can reveal useful and potentially clinical important information of the characteristics of arthritis. In conclusion, we have shown that synovitis studied by sensitive imaging methods is similar in the wrist joint and in the synovial sheaths in both PsA and RA. This technique could also contribute to investigate different aspects of inflammation that are not easily differentiated by clinical and laboratory studies.

Image Analysis is at the forefront of these exciting developments in medical imaging software, working with many of the leading institutions and key research centers. We are proud of what we achived together and would like to share our experiences with You!

To make the most of your visit to ECR we hope to have the opportunity to meet you and discuss our latest, exciting developments in medical image analysis:

• Volume Regions of Interest (ROI), with 3-D visualisation of the ROI and parametric maps
• Automatic generation of ROI’s
• Enhanced functionality for all Muskuloskeletal applications
• New parametric maps targeting Oncology, Cardio and Neuro applications

Warmest regards, Image Analysis Team

Contact us to schedule a meeting or a demo of Dynamika

Posted online on January 30, 2012

MB Axelsen¹, M Stoltenberg², RP Poggenborg¹, O Kubassova³, M Boesen^4,5, H Bliddal⁴, K Hørslev-Petersen⁶, LG Hanson^7,8, M Østergaard¹

Read More: http://informahealthcare.com/doi/abs/10.3109/03009742.2011.608375

We are pleased to announce the release of Dynamika 4.4.2, which has even more features to enhance your workflow, speed up reading of MRI and reduce a possibility of human error. Please contact sales@imageanalysis.org.uk to receive a free evaluation licence.